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superintendent there, and soon afterwards he began hisseries of 10,000 necropsies on subjects over the age ofsixty-five. With Dr. Trevor Howell he published theresults of his observations based on this work inGeriutrics, from 1949 to 1953, in a collection of articles,under the general title of De Sedibus Morborum inSenectute. Modest and retiring, Dr. Piggot avoidedpublic notice and few of his colleagues understood howmuch he had accomplished.His wife survives him with a son and a daughter, Dr.
Rosa Piggot, who is assistant medical officer of healthfor Reading.
HERBERT LESLIE MILLES
M.C., M.A. Camb., M.H.C.P.Dr. H. L. Milles, physician to the Worcester Royal
Infirmary and to the Royal Brine Baths Clinic atDroitwich, died on Jan. 18.He took up medicine after the first world war, during
which he won the Military Cross, and after studyingat Cambridge and King’s College Hospital he qualifiedin 1926. He held resident appointments there and atEdinburgh Royal Infirmary, later returning to King’sas a medical registrar. He became M.R.c.P. in 1931.A special interest in rheumatism led him to settle in
Droitwich. When the second world war came, andmedical practice in the spa was disorganised, he wasappointed deputy medical superintendent at BarnsleyHall Emergency Hospital. With his customaryenthusiasm he threw himself wholeheartedly into thisnew venture, acting as physician in charge of the medicaldivision and encouraging the social life of the patients.He formed many new friendships with the Birminghamconsultants who visited the hospital. In 1942 he wasappointed an extra physician at the Worcester RoyalInfirmary and straightaway instituted an electrocardio-graphic department. After a serious illness in 1947he was allowed to resume only limited work.A colleague writes : " Highly strung by nature, Milles
was always cheerful and friendly, finding happiness in allthat he did. An unusual clinical problem would assuredlyexcite his attention, and, disregarding the injunction of hismedical advisers, he would hurry off to share the interestof it with a colleague ; but never would his enthusiasmbe allowed to impair his clinical judgment. He often gavean impression of being in a hurry ; and indeed he walked
characteristically with a slight forward stoop, as if he wastrying to catch up on time. At meetings he could be reliedupon to produce something of interest, but in the excite-ment of the moment he did not always marshal his facts tothe best advantage.
" Whatever he took up.he did enthusiastically. Before hisillness he was a keen tennis-player, a knowledgeable andpractical gardener, and an able driver of a well-proven andfaithful Lancia. Latteriy he confined his outdoor activitiesto fishing and painting, enjoying to the full the tranquillityof the nearby valley of the Teme. At home his familyshared his interests : he read widely and took pleasure in hiscollection of gramophone records of which he was very proud."
Mrs. Milles survives him with four children.
WE record with regret the death of Mr. S. C. EAST, avalued member of the staff of THE LANCET for more thanhalf a century. Entering our office in 1887 as a boy of14, he became one of its main supports ; and to genera-tions of medical visitors and advertisers gave a cheerfulwelcome and ready help which brought him many friends.He retired in 1939 and attained his 81st year.
Births, Marriages, and DeathsBIRTHS
EDWARDS.—On Jan. 22, at the Maternity Hospital, Leeds, to Helen(nee Garner), wife of Dr. Gordon Edwards—a third daughter(Margot Lesley).
HABIBIS.—On Jan. 12, at Queen. Charlotte’s Hospital, to StellaM. Murray, M.B.. D.c.H., wife of Dr. Homer S. Habibis, lA,Yorchester Terrace, W.2—a daughter (their fourth child).
WATSON.—On Jan. 20, at Del Rey House, Cheltenham, Lieut.-Colonel Charles Henry Watson, D.S.O., I.M.S. retd.
Diary of the Week
JAN. 31 TO FE]3. 6Tuesday, 2ndBRITISH POSTGRADUATE MEDICAL FEDERATION
5.30 P.M. (London School of Hygiene and Tropical MedicimKeppel Street, W.C.I.) Prof. L. P. Garrod: Causes cFailure in Antibiotic Therapy.
ST. MARf’s HOSPITAL MEDICAL SCHOOL, Paddington, W.25 P.M. Mr. J. R. Armstrong, Mr. Aleck Bourne : Backache i
Wednesday, 3rdROYAL SOCIETY OF MEDICINE, 1, Wimpole Street, W.1
5.15 P.m. Sections of History of Medicine and Odontoloy. Pro]Humphrey Humphreys : Dental Operations Practiseiin Primitive Communities. (C. E. Wallis lecture.)
8 P.M. Section of Surgery. Mr. Alan Hunt, Mr. Norman TanneiDr. E. R. Cullinan : Portal Hypertension.
INSTITUTE OF DERMATOLOGY, St. John’s Hospital, Lisle StreetW.C.2
5.30 P.M. Dr. R. W. Riddell : Practical Diagnosis of SuperficiaMycoses.
INSTITUTE OF LARYNGOLOGY AND OTOLOGY, 330, Gray’s Inn Road- W.C.1
5.30 P.M. Prof. P. Van de Calseyde (Bruges): Bronchial Disease!and Pathology of Upper Respiratory Tract.
MIDLAND MEDICAL SOCIETY8.15 P.M. (Birmingham Medical Institute, 154, Great Charlet
Street, Birmingham, 3.) Dr. T. L. Hardy: Functiona.Disorders of Colon.
MANCHESTER MEDICAL SOCIETY4.30 P.M. (Medical School, University of Manchester.) Section o
Medicine. Dr. W. H. Trethowan : PsychopathologicaReactions to A.C.T.H. and Cortisone.
MEDICO-CHIRURGICAL SOCIETY OF EDINBURGH8.30 P.M. (Royal College of Surgeons, 18, Nicolson Street.;
Dr. E. H. Cameron : Forty Years of Ophthalmology.
Thursday, 4thROYAL COLLEGE OF SURGEONS, Lincoln’s Inn Fields, W.C.2
5.30 P.M. Prof. Geoffrey Hadfield : Co-carcinogenesis.UNIVERSITY OF LONDON
5.30 P.M. (School of Pharmacy, 17, Bloomsbury Square, W.C.I.)Prof. J. H. Gaddum, F.R.s. : Discoveries in Pharmacology.(First of two lectures.)
5.30 P.M. (Senate House, W.C.I.) Air Marshal Sir Harold Whitt-ingham : Medical Science and Problems of Flying.
5.30 P.M. (University College, Gower Street, W.C.I.) Prof. F.Bergel, D.80. : Chemical Aspects of Abnormal Growth.(First of two lectures.)
BRITISH POSTGRADUATE MEDICAL FEDFRATION5.30 P.M. (London School of Hygiene and Tropical Medicine.)
Prof. A. A. Miles : Reactions to Bacterial Invasion.INSTITUTE OF CHILD HFALTH, The Hospital for Sick Children,
Great Ormond Street, W.C.1 ,
5.30 P.M. Mrs. J. M. Williams: Prevention of Backwardnessat School.
MANCHESTER MEDICAL SOCIETY8 P.M. Section of Anœsthetics. Dr. E. A. Pask : James Brown.
Friday, 5thUNIVERSITY OF LONDON
5.30 P.M. (17, Bloomsbury Square, W.C.1.) Professor Gaddum:Discoveries in Pharmacology. (Second of two lectures.)
POSTGRADUATE MEDICAL SCHOOL OF LONDON, Ducane Road, W.122 P.M. Mr. J. E. Richardson : Unusual Presentation of Common
Gastric Disorders.ROYAL SOCIETY OF MEDICINE
10.30 A.M. Section of Otology. Mr. Terence Cawthorne, Dr. A. B.Hewlett: Meniere’s Disease.
2.30 P.ii. Section of Laryngology. Miss M. D. Snelling, Mr. VictorLambert: Treatment of Carcinoma of Nasopharynx.
5.30 P.M. Section of Anœsthetics. Dr. J. G. Bourne : GeneralAnaesthesia for Outpatients with special reference toDental Extraction.
INSTITUTE OF CARDIOLOGY, National Heart Hospital, WestmorelandStreet, W.1
9.30 A.M. Dr. Stanley J. Sarnoff (Harvard) : HeemodynainicEffects of a New Sympathomimetic Amine and its Use inMyocardial Infarction.
INSTITUTE OF DERMATOLOGY5.30 P.M. Dr. H. Gordon : Benign New Growths.
INSTITUTE OF NEUROLOGY, National Hospital, Queen Square, W.C.15 P.M. Prof. H. Gastaut (Marseilles) : So-called " Psychomotor"
and " Temporal " Epilepsy.WHIPPS CROSS HOSPITAL MEDICAL SOCIETY, Whipps Cross Hospital,
E.11 8.30 P.M. Dr. Hugh Ramsay : Tuberculosis Services, Yesterday
Saturday, 6thMIDLAND TUBERCULOSIS SOCIETY -
8.15 P.M. (151, Great Charles Street. Birmingham, 3.) Mr. P. B.AUison : Diseases at the Lower End of the (Esophagus.
ElEXT PÆDIATRIC SOCIETY2.15 P.M. (Roval Star Hotel, Maidstone.) Mr. Robert Percival.
Dr. P. N. Swift : Circumcision.
1. See Lancet, 1953. ii, 194.2. Ibid, 1953. i, 1085.3. Proceedings of the 8th International Hospital Congress. Obtain-
able from the International Hospital Federation, 10, OldJewry, London, E.C.2. Pp. 362. 30s.
Notes and News
CLASSIFICATION OF PROPRIETARY MEDICINES
LAST July the Joint Committee on Prescribing, under thechairmanship of Sir Henry Cohen, issued a classified listof proprietary medicines as a guide to prescription under theNational Health Service.l A list of alterations and additionshas now been published.
EPIDEMIC HIEMORRHAGIC FEVER
AT the meeting of the Royal Society of Tropical Medicineand Hygiene on Jan. 21, Lieut.-Colonel K. P. Brown andDr. A. Knudsen read papers on epidemic hæmorrhagic fever.
Lieut.-Colonel Brown described the clinical course of thedisease : the invasion phase, in which evidence of renal
damage appeared, was followed by a toxic phase whenthe temperature fell, the patient’s condition deteriorated,and there was usually hypotension and reduction in the
circulating plasma-volume, with cedema and haemorrhageswhich might be severe. Most patients started to recover asthis -condition of shock regressed, but there was commonlyan oliguric phase in which the blood-pressure rose to hyper-tensive levels. This was usually followed by diuresis andrecovery. There was no specific treatment. The mortalitywas about 5%.
Dr. Knudsen described the pathology of this strangedisease : the essential microscopic lesions were haemorrhagesin the medulla of the kidney (with ischæmic necrosis), thesuprarenal, the pituitary, the heart muscle, and other organs.But there was no inflammatory reaction, and cellular infiltra-tion was rare and, even where it did occur, scanty. Theimmediate cause of death in fatal cases was usually peripheralcirculatory collapse. Bacteriological findings have been
consistently negative, but Russian workers claimed to havetransmitted one of this group of diseases to human volunteers.Various theories on the setiology and transmission of this
disease, and of other diseases which closely resemble it,have been proposed, but the general opinion of the meetingwas that the cause was still a mystery. If it is an infectiondue to a micro-organism, why are there no signs of inflamma-tion ? If it is a toxin (and a parallel with tick paralysis wassuggested), why is there an incubation period which, in onecase, was 30 days ? 2Answering a question, Lieut.-Colonel Brown said that he
had not heard of a second attack in any patient. BrigadierF. J. O’Meara pointed out that the epidemics in Korea tendedto occur in two waves-May-June and December-January-at seasons when mite-counts on rodents had just passed theirpeak.
PREVENTIVE MEDICINE AND THE HOSPITAL
LAST May the 8th International Hospital Congress metin London,2 and now the International Hospital Federationhas published a report of the proceedings 3 at this livelygathering. The subject of the congress was PreventiveMedicine as a Major Function of the Hospital, and its
Implications. The report contains a verbatim account of theplenary sessions and the sectional group meetings. Whenhe opened the congress, the Minister of Health, Mr. lainMacleod, said that he had read in advance four of the addressesto be given to the congress and he had been enthralled withtheir freshness : " here," he said, " was a new breeze blowingdown the rather dusty corridors of our long debates on health."The published proceedings will help those who were presentto refresh the stimulus of this international debate, and thosewho were not there will be able to catch up with some of thenimblest thinkers on this subject.
LONDON SCHOOL OF HYGIENE AND TROPICALMEDICINE
IN the report on the work of the school for 1952-53, the dean,Dr. Andrew Topping, tells of continued development both inroutine teaching and in research. The three courses conductedat the school, for the diplomas in public health, bacteriology,and tropical medicine and hygiene, have had full complementsof students, including many from overseas ; and, quite apartfrom their academic advantages, the courses have promoted
1. La stérilité masculine. Paris : Association Française d’Urologie,1953.
2. Bayle, H. Proc. Soc. Stud. Fertility, 1952, 4, 27, 30.
valuable international contacts. In the school’s department ofpublic health, under the direction of Prof. J. M. Mackintosh,one aim of the course is to train students to appreciate thevalue of team-work; and, with this in mind, the system ofgroup study has been made a feature of the course for theD.P.H. The daily period of lectures for the D.P.H. has beenmuch reduced in recent years and the students, whose averageage is 33, are given more time for less formal study : theygive dissertations on subjects of their own choice, and they.keep " day-books " in which they enter critical notes on theirown reading and on visits to places of public-health importanceoutside the school. Summing up the purpose of the novelteaching methods in use in his department, Professor Mackin-tosh says that their aim is to make good general physiciansin preventive medicine ; the course is designed to be "thegateway to a career, not the badge of a specialty."
SMALL amounts of erythromycin have lately been madeavailable by the Ministry of Health to hospitals in the NationalHealth Service. Soon, this antibiotic will be freely availableon prescription and the Ministry is therefore sending to allhospitals a note, prepared by the Medical Research Council,in which the indications for the use of erythromycin and theprecautions which should be taken are set out. Erythromycinhas a range of activity similar to that of penicillin and hasbeen shown to be effective in acute infections due to hæmolyticstreptococei, pneumococci, and staphylococei. Organismsresistant to all other antibiotics are nevertheless sensitive toit : hence its greatest value is in treating staphylococcalinfections not responsive to other drugs, the frequency ofwhich, particularly in hospitals, is showing a disturbingincrease. Erythromycin is itself a drug to which bacterialresistance can be acquired rather rapidly, and the note, urgingits cautious use, points out that it might be disastrous if astaphylococcal population were built up which was resistantto erythromycin as well as to earlier antibiotics. Penicillinshould always be given when it will serve equally well.
Imperial Chemicals (Pharmaceuticals) Ltd. have produceda film illustrating some technical points in the use of inhalationanalgesia in obstetrics. In a spoken introduction to a previewin London it was explained that it should be regarded as onlysupplementary to teaching which pupil midwives and medicalstudents receive elsewhere, and for this purpose it has themerit of making its points clearly, with expert use of animateddiagrams. Where it lies chiefly open to criticism is in its title- for it does not set out to cover the whole subject of TheRelief of Pain in. Childbirth—and perhaps in its insistence thatinhalation methods approach most nearly to the ideal inobstetric analgesia. Probablv most doctors who work dailyamong women in labour would say that if they had to limitthemselves to a single analgesic, they would choose pethidine- a drug which midwives are now allowed to use in certainprescribed doses but which they seem reluctant to adopt." Severe toxaemia," but not fcetal distress, is given as a
contra-indication to gas-and-air analgesia; the effects of
quite deep anaesthesia are shown, perhaps unnecessarily ; andpractical management is touched on somewhat lightly. Forthese reasons the emphasis must, as was suggested, be on theuse of this film as a supplement to other and wider teaching.
STERILITY IN MAN
THE past decade has witnessed the advent- and perfectionof several new and powerful aids to biological and clinicalresearch on male sterility, and the need has long been felt fora book which would give a general appreciation of the entireproblem of male sterility and at the same time provide anaccount of the most recent advances. This gap has been filledby the French Urological Association in publishing a mono-graph by Dr. Henri Bayle and Dr. C. Gouygou.1 Dr. Bayle’sname is well known to British specialists in this field, manyof whom heard his excellent lectures at the conference of theSociety for the Study of Fertility in London in 1952, when hespoke on azoospermia of excretory origin and electron-
microscope studies of human spermatozoa.2 The new mono-
graph, in discussing the diagnosis and treatment of male
subfertility and sterility, includes a description of his tech-nique of vaso-epididymostomy for the relief of obstructiveazoospermia in man.